Platinum open access journal
pISSN 2466-0493 eISSN 2466-054X
Indexed in MEDLINE, SCIE, Scopus, DOAJ and more
    Korean J Urol. 2008 May;49(5):398-403. Korean.
    Published online May 31, 2008.
    https://doi.org/10.4111/kju.2008.49.5.398
    Copyright © 2008 The Korean Urological Association
    Original Article

    The Diagnostic Value of Predictive Factors for Clinically Insignificant Prostate Cancer

    Hye Won Lee, Kyung Won Kwak, Hyun Moo Lee and Han Yong Choi
    Received January 29, 2008; Accepted March 20, 2008.

    Abstract

    Purpose

    In the present study, we identified the pre-operative predictive factors of insignificant prostate cancer and we analyzed their diagnostic accuracy.

    Material and Methods

    Of a total 343 patients who had undergone radical prostatectomy, 33 patients (9.6%) were diagnosed with insignificant cancer that was characterized by a total cancer volume ≤0.5cc, a Gleason score (GS)≤6, a T stage≤2c and no positive surgical margin. We found the statistically significant factors after comparing of preoperative clinicopathological findings between two groups and determined the diagnostic accuracy of the identified predictors.

    Results

    Of several factors, prostate-specific antigen (PSA) level (p=0.04, odds ratio (OR)=4.3 3.589≤95%confidence interval (CI)≤5.692), PSA density (PSAD) (p=0.01, OR=6.6, 2.115≤95%CI≤278.826), biopsy GS (p=0.03, OR=4.6, 1.114≤95%CI≤12.568) and volume of the largest cancer (p=0.02, OR=5.6, 2.471≤95%CI≤9.725) were analyzed as independent predictors of insignificant cancer. The volume of the largest cancer was the most precise predictor (AUC=0.791), followed by the PSAD (AUC=0.748) and the PSA level (AUC=0.677) in the ROC (receiver operating characteristic) curve analysis. The sensitivity, specificity and positive predictive value for predicting insignificant cancer were 10.3%, 63.7% and 12.8% at a PSA level of 10ng/ml, and 44.8%, 16.8% and 26.3% at a PSAD of 0.15ng/ml/ml, and 13.8%, 53.8% and 14.2% at a volume of the largest cancer of 50%, respectively. Even with using a combination of these three factors as well as a biopsy GS≤6, only 53% of insignificant prostate cancer could be predicted preoperatively.

    Conclusions

    In our study, PSA level, PSAD, biopsy GS and volume of the largest cancer were identified as predictors of insignificant cancer in spite of their unsatisfactory diagnostic accuracy.

    Keywords
    Prostate cancer; Prostatectomy; Insignificant; Predictive

    Figures

    Fig. 1
    The ROC curve analysis of the PSA, PSAD and the volume of the largest cancer for predicting insignificant prostate cancer is shown below. Area under curve: volume of the largest cancer; 0.791 PSAD; 0.748 PSA; 0.677. ROC: receiver operating characteristic, PSA: prostate-specific antigen, PSAD: prostate-specific antigen density, PPV: positive predictive value.

    Tables

    Table 1
    Comparison of clinical tumor characteristics of the 343 patients and who are stratified by the pathological insignificance of their cancer

    Table 2
    The univariate and multivariate analyses of the pre-operative parameters for insignificant prostate cancer

    Table 3
    The sensitivity, specificity and PPV of each parameter for predicting insignificant prostate cancer

    References

      1. Stamey TA, Freiha FS, McNeal JE, Redwine EA, Whittemore AS, Schmid HP. Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 1993;71(3 Suppl):933–938.
      1. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994;271:368–374.
      1. Klein EA. What is 'insignificant' prostate carcinoma? Cancer 2004;101:1923–1925.
      1. Anast JW, Andriole GL, Bismar TA, Yan Y, Humphrey PA. Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population? Urology 2004;64:544–550.
      1. Augustin H, Hammerer PG, Graefen M, Erbersdobler A, Blonski J, Palisaar J, et al. Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. Eur Urol 2003;43:455–460.
      1. Wang X, Brannigan RE, Rademaker AW, McVary KT, Oyasu R. One core positive prostate biopsy is a poor predictor of cancer volume in the radical prostatectomy specimen. J Urol 1997;158:1431–1435.
      1. Thorson P, Vollmer RT, Arcangeli C, Keetch DW, Humphrey PA. Minimal carcinoma in prostate needle biopsy specimens: diagnostic features and radical prostatectomy follow-up. Mod Pathol 1998;11:543–551.
      1. D'Amico AV, Wu Y, Chen MH, Nash M, Renshaw AA, Richie JP. Pathologic findings and prostate specific antigen outcome after radical prostatectomy for patients diagnosed on the basis of a single microscopic focus of prostate carcinoma with a gleason score </= 7. Cancer 2000;89:1810–1817.
      1. Allan RW, Sanderson H, Epstein JI. Correlation of minute (0.5 MM or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density. J Urol 2003;170:370–372.
      1. Ravery V, Szabo J, Toublanc M, Boccon-Gibod LA, Billebaud T, Hermieu JF, et al. A single positive prostate biopsy in six does not predict a low-volume prostate tumour. Br J Urol 1996;77:724–728.
      1. Boccon-Gibod LM, Dumonceau O, Toublanc M, Ravery V, Boccon-Gibod LA. Micro-focal prostate cancer: a comparison of biopsy and radical prostatectomy specimen features. Eur Urol 2005;48:895–899.
      1. Lee AK, Doytchinova T, Chen MH, Renshaw AA, Weinstein M, Richie JP, et al. Can the core length involved with prostate cancer identify clinically insignificant disease in low risk patients diagnosed on the basis of a single positive core? Urol Oncol 2003;21:123–127.
      1. Goto Y, Ohori M, Arakawa A, Kattan MW, Wheeler TM, Scardino PT. Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 1996;156:1059–1063.
      1. Soh S, Kattan MW, Berkman S, Wheeler TM, Scardino PT. Has there been a recent shift in the pathological features and prognosis of patients treated with radical prostatectomy? J Urol 1997;157:2212–2218.
      1. Ohori M. The pathological features and prognosis of prostate cancer detectable with current diagnostic tests. J Urol 1994;152:1714–1730.
      1. Carter HB, Sauvageot J, Walsh PC, Epstein JI. Prospective evaluation of men with stage T1c adenocarcinoma of the prostate. J Urol 1997;157:2206–2209.
      1. Gardner TA, Lemer ML, Schlegel PN, Waldbaum RS, Vaughan ED Jr, Steckel J. Microfocal prostate cancer: biopsy cancer volume does not predict actual tumour volume. Br J Urol 1998;81:839–843.
      1. Terris MK, Haney DJ, Johnstone IM, McNeal JE, Stamey TA. Prediction of prostate cancer volume using prostate-specific antigen levels, transrectal ultrasound, and systematic sextant biopsies. Urology 1995;45:75–80.
      1. Steinberg GD, Bales GT, Brendler CB. An analysis of watchful waiting for clinically localized prostate cancer. J Urol 1998;159:1431–1436.
      1. Sohn DW, Byun SS, Lee SE. Predictive factors and characteristics of the prostate cancer in patients with serum PSA levels equal or less than 4.0ng/ml. Korean J Urol 2005;46:565–568.
      1. Park HK, Hong SK, Byun SS, Lee SE. Comparison of the rate of detecting prostate cancer and the pathologic characteristics of the patients with a serum PSA level in the range of 3.0 to 4.0ng/ml and the patients with a serum PSA level in the range 4.1 to 10.0ng/ml. Korean J Urol 2006;47:358–361.
      1. Andren O, Fall K, Franzen L, Andersson SO, Johansson JE, Rubin MA. How well does the Gleason score predict prostate cancer death? A 20-year followup of a population based cohort in Sweden. J Urol 2006;175:1337–1340.
      1. Kim YJ, Lee SC, Chang IH, Gil MC, Hong SK, Byun SS, et al. Clinical significance of a single-core positive prostate cancers detected on extended prostate needle biopsy. Korean J Urol 2006;47:475–481.
      1. Klotz L. Active surveillance for favorable risk prostate cancer: rationale, risks, and results. Urol Oncol 2007;25:505–509.
      1. King CR, McNeal JE, Gill H, Presti JC Jr. Extended prostate biopsy scheme improves reliability of Gleason grading: implications for radiotherapy patients. Int J Radiat Oncol Biol Phys 2004;59:386–391.
      1. Hyun CL, Lee HE, Kim H, Lee HS, Park SY, Chung JH, et al. Pathological analysis of 1,000 cases of transrectal ultrasoundguided systematic prostate biopsy: establishment of new sample processing method and diagnostic utility of immunohistochemistry. Korean J Pathol 2006;40:406–419.
    Cited by
    Crossref 3
    Google Scholar 
    Scopus 3
    MeSH Terms
    Biopsy
    Humans
    Neoplasm Grading
    Prostate
    Prostatectomy
    Prostatic Neoplasms
    Sensitivity and Specificity
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide
    slide
    slide

    1 / 3

    PERMALINK